ABSTRACT: Both comparative and single-race studies suggest that sleep disorders are at least as prevalent among American Indians and Alaska Natives (AI/ANs) as they are in the all-races population. Sleep problems are known to be important contributors to chronic disease and early mortality in all populations, while effective treatment of sleep disorders improves the management of diverse health conditions. We propose to conduct an innovative mixed-methods study ? American Indian CHronic disEase RIsk and Sleep Health (AI- CHERISH) ? to assess the relationship between CVD and metabolic risk and sleep health in the context of Native culture. During the first 2 project years, we will conduct 5 focus groups (15 groups total; 12 participants each) and 2 rounds of semi-structured interviews with 5 key informants (30 interviews total). The resulting qualitative data will inform the development of a patient-reported outcome measure (PROM) of sleep health, to augment established measures accounting for factors specific to Native communities, and culturally-grounded, complementary guidelines for improving sleep. In the quantitative portion of this work, we will implement the largest epidemiologic study of sleep health to date with an AI/AN sample to assess the population prevalence of sleep deficiencies and their association with specific CVD risk factors. Participants in the epidemiologic study were previously enrolled in the Strong Heart Family Study (SHFS). For the epidemiologic study, we will recruit 250 AI participants aged 30?50 years from each geographic region (N=750) and collect sleep data from each participant during 2 study visits in a single 9-month period, with a visit during the months with the longest and shortest daylight exposure (May?July and November?January). For 7 days before each data collection visit, participants will wear wrist actigraphs to measure sleeping and waking activities, and will keep a diary to document waking activities as well as sleep duration, consolidation, and timing. When they return the actigraphs, they will complete 4 validated self-report instruments: the Pittsburgh Sleep Quality Index, the Epworth Sleepiness Scale, the Sleep Hygiene Index, the Insomnia Severity Index, and the STOP-Bang questionnaire. They will also provide data on sociodemographics and on CVD risk factors (blood lipids, hemoglobin A1C, blood pressure, BMI) known to be influenced by sleep. Our Specific Aims are to: 1) Develop a culturally appropriate PROM of sleep health based on the local context affecting sleep at each study site by using focus groups. 2) In key informant interviews, evaluate existing guidelines and elucidate complementary culturally-grounded guidelines for improving sleep health at each study site to augment existing guidelines for AI communities. 3) Estimate the prevalence and nature of sleep deficiencies in a sample of 750 AI adults at 3 study sites by analyzing objective data from actigraphy and subjective data from sleep/wake diaries and standardized sleep instruments collected at 2 time points during a 9-month period. 4) Assess the cross-sectional associations of poor sleep health, as defined by our objective and subjective sleep measures, with CVD and metabolic risk factors.